New Therapeutic Approach to Treat Allergic Rhinitis & Bronchial Asthma, Considering These Two as One United Airway Disease.

The relationship between allergic rhinitis and asthma is now established, and most of the clinical, epidemiological and biological data recommend integrated management. This review discusses rhinosinusitis as a co-morbid condition, a precipitating or triggering condition, and an epiphenomenon as an integrated part of the disease. A better understanding and a more pragmatic method of diagnosis and management is needed using cost-effective long-term strategies. Allergic Rhinitis, though a non-life threatening disease, its pathogenesis reveals that Bronchial Asthma also develops by the same aetiopathogenesis. The United airway disease hypothesis proposes that the upper & lower airway diseases are both manifestations of a single inflammatory process and studies have already proved it. Allergic Rhinitis when once develops if not treated vigorously, can later turn up to Asthma. As chronic inflammation is the central process which is actually continuously changing pathologically the lower respiratory tract & helping to develop Bronchial Asthma. The conventional therapies for Allergic Rhinitis such as antihistamines & decongestants are only symptom relievers, to stop the ongoing pathogenesis of Bronchial Asthma to develop it, the chronic inflammatory process should have to be stopped. This can be done by corticosteroid nasal sprays. Also Asthma with Rhinitis is better controlled by them. Even Bronchial Asthma treatment should be started with inhaler corticosteroid therapy rather than getting it after intermittent use of only bronchodilators (salbutamol) only.

Primary Sclerosing Cholangitis in a Young Female.

Primary sclerosing cholangitis (PSC) is a liver disease characterized by inflammation and fibrosis of both intrahepatic and extrahepatic bile ducts resulting in cholestasis. Due to nonspecific symptoms it is difficult to diagnose until complication arises. It is common in male and usually associated with other autoimmune diseases. Here, we report a case of PSC in a young female which was initially thought to be drug induced cholestasis without presence of any other autoimmunity.

Celiac Disease in Patients Fulfilling the Rome III Criteria for Irritable Bowel Syndrome Attending Gastroenterology Department of A Tertiary Care Hospital in Bangladesh.

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

Prevalence of Organic Colonic Lesions by Colonoscopy in Patients with Irritable Bowel Syndrome Fulfilling Rome III Criteria.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder usually diagnosed by using symptom-based diagnostic criteria. Recent evidence suggests the presence of organic diseases in some patients fulfilling the diagnostic criteria of IBS which may be missed unless investigations are performed. The aim of this cross-sectional study is to find out the prevalence of organic colonic lesions at colonoscopy in patients with IBS fulfilling the Rome III criteria.The study was conducted in the department of Gastroenterology OPD of the North East Medical College, Sylhet, Bangladesh from December 2016 to December 2017. Consecutive 153 patients of IBS diagnosed by validated Bangla version of ROME III criteria were included in this study. Colonoscopy was done for each patient and findings were recorded. Prevalence of colonic disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype. A substantial number of patients 43(28.1%) fulfilling the Rome III criteria were found to have organic colonic lesions at colonoscopy. No significant difference was found regarding colonic lesions among patients with IBS symptoms with or without alarm features (p=0.876). Colonic polyp was the commonest findings in 19(12.1%) subjects at colonoscopy, followed by colonic ulcers in 16(10.5%) subjects. Organic colonic lesions are found to be more common among relatively older age group patients (p=0.011). A significant number of patients with symptoms compatible with IBS exhibited colonic lesions following investigation with a predilection towards older age. Careful clinical evaluation and relevant investigations are necessary to reduce diagnostic uncertainty.

MDM2 SNP 285 is Associated with Reduced Lung Cancer Risk in Bangladeshi Population.

The MDM2 gene is a negative regulator of p53, which has been linked to lung cancer. Here, we have evaluated the association of MDM2 SNP 285 G>C (rs117039649) and SNP 354 A>G (rs769412) with lung cancer risk in Bangladeshi population at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from July 2015 to June 2017. We have genotyped 126 lung cancer patients and 133 healthy controls from Bangladesh by PCR-RFLP method for this study. Statistical analyses were performed to define the associations. Multivariate logistic regression revealed that MDM2 SNP 285 decreases the risk of lung cancer (GC+CC vs. GG: OR = 0.29, 95% CI = 0.15-0.56, p<0.005). A stratification analysis confirmed that this protective status is extended to younger people, male, overweight people, and smokers (GC+CC vs. GG: OR = 0.25-0.29, 95% CI = 0.11-0.69, p<0.01). However, we did not find any association of SNP 354 with lung cancer risk in Bangladeshi population (p>0.05). The present data indicated that MDM2 SNP 285 G>C (rs117039649) reduces the chance of lung cancer development in Bangladeshi population. However, MDM2 SNP 354 A>G (rs769412) has no such association in the same population.

Study of Vitamin D Deficiency among the Apparently Healthy Population in Jashore, Bangladesh.

Globally Vitamin D deficiency is a burning issue for the last two decades. Though the very high prevalence of hypovitaminosis D is worldwide even in the South-East Asia but there is very limited data in Bangladesh. This observational study was designed to assess the status of Vitamin D deficiency among the clinically apparent healthy population in the district of Jessore, Bangladesh from January 2017 to June 2017. Both the male and female clinically healthy participants between the age of 10 and 70 years residing more than 3 years in Jashore were included in this study, while those having renal or liver failure or any other chronic diseases and using drugs that could potentially interfere the metabolism of vitamin D were excluded from the study. Here we leveled serum 25(OH)D concentration of ≤20ngm/dl as deficient, >20-30ngm/dl graded as insufficient and >30ngm/dl graded as sufficient. Among 160 participants 43.1% (n=69) were male and 56.9% (n=91) were female. And 102(63.7%) participants had deficient vitamin D, 50(31.3%) had insufficient vitamin D and only 8(5%) had sufficient vitamin D. The mean serum 25(OH)D levels in our study was 18.60±6.59ngm/dl. The mean serum 25(OH)D level in case of male participants was 19.72±7.10ngm/dl whereas in female the corresponding figure was 17.74±6.07gm/dl and no significant difference observed among the man and women (p=0.059). Sun exposure play a vital role in the vitamin D deficiency and we observed only 1-2 hours/day sun exposure was sufficient for normal vitamin D level (p=0.001). In case of women who used veil had significantly lower level of vitamin D (p=<0.001) due to lack of adequate sun exposure. Urban participants who also had significant low level of vitamin D due to the same reason (p=0.009). There was no deficiency observed in farmers and only 5(3.1%) had insufficient vitamin D. No significant difference observed in deficiency of vitamin D among the different age, sex, education level, skin complexion or BMI. But the obese participants had significant (p=0.041) lower vitamin D level. It was concluded with the high rate of vitamin D deficiency in this small scale study conducting in a district of Bangladesh demands a nationwide survey of vitamin D.

Thyroid Status in Children with Transfusion Dependent Hb-E ß-Thalassaemia.

Despite improved haematological care, multi-endocrine dysfunction is a common complication in thalassemia. Iron overload is thought to be the most likely mechanism in thyroid dysfunction in these patients. Moreover, chronic tissue hypoxia might havedirect toxic effect on thyroid gland resulting in hypothyroidism. This study was designed to evaluate the thyroid status of children with Hb-E ß-thalassemia. This cross sectional analytic study was conducted among thepatients with Hb-E ß-thalassemia attending both in-patient & out-patient department of Paediatrics, Dhaka Medical College & Hospital, Dhaka, Bangladesh from April 2012 to March 2013. The children who attended inpatient and outpatient department of Paediatrics for some other illness were screened out for thalassaemia and were recruited as comparison group. Thyroid function tests (TSH & FT4 level) were performed in both thalassaemic patients and comparison group. Serum ferritin level was also measured for assessing iron status of thalassaemic patients and their pre-transfusion Hb levels were recorded in the pre-formed data collection form. Of the 50 thalassaemia patients, 13(26%) had subclinical hypothyroidism. This proportion of subclinical hypothyroidism was significantly high, compared to that (2.5%) of non thalassaemia comparison group. Among the subclinically hypothyroid thalassaemia subjects, 8 were males and 5 were females and their mean age was 102.38±33.29 months. The mean serum ferritin levels in hypothyroid and euthyroid thalassaemia cases were 2387.87±1642.85ng/ml and 1822.95±1345.33ng/ml respectively (normal level upto 300ng/ml). This difference was not statistically significant (p=0.279); but the pre-transfusion Hb level wasfound significantly different (p=0.02) among the two groups. It was 5.57±0.98g/dl in hypothyroid & 6.37±0.09g/dl in euthyroid thalassaemic cases. Subclinical hypothyroidism was quite high among the children with transfusion dependent Hb-E ß-thalassaemia. Their hypothyroid status had no significant correlation with their serum ferritin level but had significant correlation with low haemoglobin status.

Urogenital anomalies associated with anorectal malformations in children.

The urogenital tract is the most severe and common site of associated defects in anorectal malformations (ARM). Urogenital anomalies and their complications significantly increase the morbidity in these children after the ARM is corrected. The purpose of this study was to estimate the incidence of different types of urogenital anomalies with various types of anorectal malformations and to discuss the possible management and outcome. A retrospective study of patients with ARM and associated urogenital abnormalities admitted in the department of paediatric surgery of Sylhet MAG Osmani Medical College Hospital between 1998 and 2002 was undertaken. A total of 155 patients with Anorectal malformations were admitted of which 47 (30.32%) patients had associated anomalies involving other systems. Urogenital abnormalities were found in 25 (16.13%) patients. Patients of Anorectal malformations with urogenital abnormalities require careful assessment and well-timed intervention to minimize the morbidity.

Calcium channel blockers and mortality in elderly patients with myocardial infarction.

BACKGROUND: Although calcium channel blockers are a useful therapy in relieving angina, lowering blood pressure, and slowing conduction of atrial fibrillation, growing evidence has cast doubt on their safety in patients with coronary disease. OBJECTIVE: To examine the association between calcium channel blocker therapy at hospital discharge and mortality in a population-based sample of elderly patients hospitalized with acute myocardial infarction. DESIGN: Retrospective cohort study using data from medical charts and administrative files. SETTING: All acute care hospitals in 46 states. PATIENTS: All Medicare patients with a principal diagnosis of acute myocardial infarction consecutively discharged from the hospital alive during 8-month periods between 1994 and 1995 (N = 141,041). MAIN OUTCOME MEASURE: Mortality at 30 days and 1 year. RESULTS: Calcium channel blockers were widely prescribed at hospital discharge to elderly patients with myocardial infarction between 1994 and 1995 (n = 51,921), the most commonly prescribed being diltiazem (n = 21,175), nifedipine (n = 12,670), amlodipine (n = 11,683), and verapamil (n = 3639). After adjusting for illness severity and concomitant medication use, patients who were prescribed calcium channel blockers at hospital discharge did not have increased risk for 30-day or 1-year mortality, with the exception of the few (n = 116) treated with bepridil. Bepridil differs from other calcium channel blockers because of its tendency to prolong repolarization, and its association with proarrhythmic effects in elderly patients. CONCLUSION: We did not identify a mortality risk in a large consecutive sample of elderly patients with myocardial infarction, which supports the need for additional prospective trials examining calcium channel blocker therapy for ischemic heart disease.

Alternative anthropometric indicators of mortality.

The ability of anthropometric indicators, weight-for-age, height-for-age, weight-for-height, weight velocity, and height velocity to discriminate mortality during a one-year period is examined for three time frames beginning in different seasons. Data on approximately 1,000 children of one to four years of age come from the Matlab, International Centre for Diarrhoeal Disease Research, Bangladesh. The indicators' mortality-discriminating power is assessed in terms of the magnitude of difference between the mean indicator values of living and dead children expressed in standard deviation units and of the maximum sum of sensitivity and specificity. The indicators' mortality curve by nutritional status shows the discriminating power visually; the t test indicates its statistical significance. Weight-for-age and height-for-age perform better than weight velocity and height velocity as discriminators of mortality during a one-year period. The ability of weight and height velocity to discriminate short-term mortality is examined by comparing the mean velocity of the last two bimonthly intervals of the dead children. Weight velocity is likely to be a good indicator of short-term mortality.

Socioeconomic and anthropometric status, and mortality of young children in rural Bangladesh.

This article investigates the interrelationship of socioeconemic status, anthropometric status and mortality of young children in rural Bangladesh. Data for this study come from Matlab, the vital registration area of the International Centre for Diarrhoeal Disease Research, Bangladesh, where anthropometric and socioeconomic data concerning 1976 children aged 12-23 months were collected in November-December 1975. From these data, anthropometric indices are created, and the relationships of socioeconomic status measured by dwelling space and anthropometric indices with mortality during the 2 years following measurement of these children are investigated. It is found that both socioeconomic status and anthropometric indices are related to mortality. However, the relationship of anthropometric indices is much stronger. Among the anthropometric indices considered, weight-for-age, height-for-age and arm circumference reflect socioeconomic status better than weight-for-height does; and, the first three indices are equally good, and individually better than weight-for-height, as predictors of mortality. The degree of the effect of socioeconomic status (dwelling space) on mortality explained by the best performing anthropometric index, weight-for-age, was not more than 25%. It is concluded that an anthropometric index that can classify socioeconomic status more efficiently is a better predictor of 2-year mortality than any other anthropometric index.

Sex differences and sustained excess in mortality among discordant twins in Matlab, Bangladesh: 1977-1985.

This paper reports findings from a study that compared survival of 204 pairs of liveborn twins discordant for sex and a random sample of 2371 singleton live births from the same population in Matlab, Bangladesh during the period 1977-1985. The discordant twins showed no evidence of sex differential in neonatal survival. They had neonatal mortality of 287 and infant mortality of 468, both per 1000 live births. These rates were respectively five and four times the rate for singletons in the study. Survival from 12 months through age nine years was similar overall for both discordant twins and singletons for each sex. However, higher female than male mortality was present among discordant twins after the first few months of life. This differential was most prominent during the second year of life and appeared wider than that observed for the singletons.

PIP: This paper reports findings from a study that compared survival of 204 pairs of liveborn twins of different sex and random sample of 2371 singleton livebirths from the same population in Matlab, Bangladesh during 1977-85. The different-sex twins showed no evidence of sex differential in neonatal survival. They had a neonatal mortality of 287 and an infant mortality of 468, both/1000 livebirths. These rates were respectively 5 and 4 times the rate for singletons in this study. Survival from 12 months through 9 years was similar overall for both different-sex twins and singletons of each sex. However, higher female mortality was seen among different-sex twins after the 1st months of life. This differential was most prominent during the 2nd year of life and appeared wider than that observed for the singletons.

The association between malnutrition and diarrhoea in rural Bangladesh.

The interaction between diarrhoeal disease and nutritional status measured by anthropometry was investigated in approximately 1000 children aged 1 to 4 years during April-December 1976 in a rural area of Bangladesh. Data on diarrhoeal disease were provided by the mothers interviewed at seven-day intervals. Weight and height data were collected bimonthly. Children classified using anthropometric criteria--weight-for-age, height-for-age, and weight-for-height--were prospectively evaluated for incidence and duration of diarrhoea during a short (two-month) period and a long (eight-month) period. Incidence of diarrhoea was not found to be related to nutritional status measured by any of the anthropometric criteria for any of the periods. But duration of diarrhoea was found to be related consistently to nutritional status measured by weight-for-age and weight-for-height. Diarrhoea in the short term affected weight increment in the short term, but not in the long term and did not affect height increment for any of these periods. Diarrhoea in the long term affected both weight increment and height increment in the long term.

Seasonality of classical and El Tor cholera in Dhaka, Bangladesh: 17-year trends.

Data on the cholera patients admitted monthly to the ICDDR, B, hospital in Dhaka (Bangladesh) from 1964 through 1980 have been studied and analysed. Although Vibrio cholerae variant El Tor did not enter Bangladesh until 1963, it has completely displaced classical cholera since 1973. There have also been changes in seasonality, which are discussed.

Does malnutrition predispose to diarrhoea during childhood? Evidence from a longitudinal study in Matlab, Bangladesh.

It is posited that diarrhoeal illness during one period has influence on diarrhoeal illness in a subsequent period. This relationship may potentially mask the association between malnutrition and subsequent diarrhoea. To test this, we analysed data on cross-sectional anthropometry in combination with data on diarrhoeal morbidity collected longitudinally in a community-based study of 1262 children (aged 6-60 months) during March-December, 1976, in Matlab, Bangladesh. The results confirmed the posited relationship between diarrhoeal morbidities in two consecutive periods and showed that the risks of diarrhoeal attack and longer diarrhoeal illness increased more than threefold during the 2 months following diarrhoeal illness during the preceding 2 months (previous diarrhoea). Children with no previous diarrhoea indicated a positive association between malnutrition and subsequent diarrhoea, but the pattern found among children with previous diarrhoea was not understandable. Logistic regression analyses performed separately for younger and older children showed that controlling for effects of previous diarrhoea, maternal illiteracy and household poverty, severe malnutrition as assessed by weight-for-age was found to be strongly associated with the risk of longer diarrhoeal illness in a 2-month interval in the age group 24-60 months; in the same age group the association with the risk of diarrhoeal attack was significant at the 10 per cent level. No such association for malnutrition, however, was found in the age group 6-23 months.

Evaluation of five promoters for use in transformation of oil palm (Elaeis guineensis Jacq.).

The efficiency of GUS (ß-Glucuronidase) gene expression in embryogenic callus and young leaflets of mature and seedling palm after microprojectile bombardment with five constructs (pEmuGN, pAHC25, pAct1-F4, pGH24 and pBARGUS) was evaluated to identify the most suitable promoter(s) to use in transformation attempts in oil palm. Expression of the GUS gene driven by theEmu, Ubi1, Act1 35S orAdh1 was assayed, both histochemically and fluorometrically, from a total of 200 plates of tissues in eight independent experiments two days after bombardment. A completely randomized experimental design was used for each experiment, and the data analysed by ANOVA and Duncan's Multiple Range Test. The expression level of GUS driven by theEmu orUbi1 promoters was significantly higher than that of the Act], 35S and Adhl promoters in many experiments, and that of theAdhl was significantly lower than those of the other four promoters. Both histochemical and fluorometric data indicate that in embryogenic callus, the expression of theEmu promoter was higher than that of theUbi1 whereas in young leaflets from mature palm the Ubi1 expression was stronger. The performances of the five promoters were also tested in tobacco callus using a fluorometric GUS assay. The activity of the 35S promoter was highest, and significantly different from that of all the other promoters except theEmu, and that of theAct1 promoter was lowest. These results indicate that either theUbil orEmu promoter should facilitate the expression of desired genes in oil palm and aid in development of an efficient stable transformation system.

Frusemide-induced diabetes mellitus in insulin pretreated rabbits as an experimental model.

Single dose of frusemide 0.1 mg/kg orally was administered in 10 rabbits pretreated with soluble insulin 4 IU intravenously. Induction of diabetes after 24 h was confirmed by an increase in blood sugar and glucosylated haemoglobin and a decrease in serum insulin levels. Ten diabetic rabbits which received only frusemide without insulin pretreatment were used as controls, whereas equal number of insulin-pretreated rabbits receiving hydrochlorothiazide 250 mg/kg orally served as the positive control group. All biochemical parameters remained unaltered in the frusemide-treated test group as well as the positive control group after two weeks. The pancreatotoxic effect of frusemide may induce a stable hyperglycaemic state in rabbits which could lead to a useful diabetic model.

Hepatic lesions caused by excretory and secretory products of Ascaris lumbricoides in golden hamster.

OBJECTIVE: To ascertain the role of excretory and secretory (ES) products of Ascaris lumbricoides in liver damage. METHODS: The ES products of A lumbricoides were collected in vitro and their SDS-PAGE analysis was done. Feeding and subcutaneous injection of ES products were done in hamsters. Estimation of serum proteins, alkaline phosphatase and alanine aminotransferase and histology of liver were carried out. Control animal experiments were done concurrently. RESULTS: The ES products of A lumbricoides contained several proteins ranging in molecular weight from 14 to 205 Kd. Prolonged feeding of ES products caused elevation of ALT and amyloid deposition in the liver, whereas short term feeding or subcutaneous challenge caused focal cell necrosis and granuloma formation in the liver. CONCLUSION: ES products of A lumbricoides can produce liver damage.